Korean J Radiol.  2019 Jan;20(1):102-113. 10.3348/kjr.2018.0237.

Semiautomatic Three-Dimensional Threshold-Based Cardiac Computed Tomography Ventricular Volumetry in Repaired Tetralogy of Fallot: Comparison with Cardiac Magnetic Resonance Imaging

• Goo HW

• KMID: 2429924
• DOI: http://doi.org/10.3348/kjr.2018.0237

Abstract

OBJECTIVE
To assess the accuracy and potential bias of computed tomography (CT) ventricular volumetry using semiautomatic three-dimensional (3D) threshold-based segmentation in repaired tetralogy of Fallot, and to compare them to those of two-dimensional (2D) magnetic resonance imaging (MRI).
MATERIALS AND METHODS
This retrospective study evaluated 32 patients with repaired tetralogy of Fallot who had undergone both cardiac CT and MRI within 3 years. For ventricular volumetry, semiautomatic 3D threshold-based segmentation was used in CT, while a manual simplified contouring 2D method was used in MRI. The indexed ventricular volumes were compared between CT and MRI. The indexed ventricular stroke volumes were compared with the indexed arterial stroke volumes measured using phase-contrast MRI. The mean differences and degrees of agreement in the indexed ventricular and stroke volumes were evaluated using Bland-Altman analysis.
RESULTS
The indexed end-systolic (ES) volumes showed no significant difference between CT and MRI (p > 0.05), while the indexed end-diastolic (ED) volumes were significantly larger on CT than on MRI (93.6 ± 17.5 mL/m² vs. 87.3 ± 15.5 mL/m² for the left ventricle [p < 0.001] and 177.2 ± 39.5 mL/m² vs. 161.7 ± 33.1 mL/m² for the right ventricle [p < 0.001], respectively). The mean differences between CT and MRI were smaller for the indexed ES volumes (2.0-2.5 mL/m²) than for the indexed ED volumes (6.3-15.5 mL/m²). CT overestimated the stroke volumes by 14-16%. With phase-contrast MRI as a reference, CT (7.2-14.3 mL/m²) showed greater mean differences in the indexed stroke volumes than did MRI (0.8-3.3 mL/m²; p < 0.005).
CONCLUSION
Compared to 2D MRI, CT ventricular volumetry using semiautomatic 3D threshold-based segmentation provides comparable ES volumes, but overestimates the ED and stroke volumes in patients with repaired tetralogy of Fallot.

Keyword

Cardiac CT; Cardiac MRI; Ventricle function; Cardiac volumetric quantification; Congenital heart disease; Threshold-based segmentation

MeSH Terms

Bias (Epidemiology)
Heart Defects, Congenital
Heart Ventricles
Humans
Magnetic Resonance Imaging*
Methods
Retrospective Studies
Stroke Volume
Tetralogy of Fallot*

Figure

• 

  Fig. 1 18-year-old female patient with repaired tetralogy of Fallot.Short-axis reformatted ES cardiac computed tomographic images show left ventricular cavity (A) and right ventricular cavity (B) segmented using three-dimensional threshold-based method in pink. Papillary muscles and trabeculations are largely excluded from ventricular cavity by using this method. C. Histogram shows that threshold (vertical line) used for segmentation is more closely located to distribution curve of M than to that of ventricular B in order to exclude voxels consisting of 100% ventricular M consistently. As result, small subset of voxels comprising variable mixtures of myocardial and B tissues between two peaks (horizontal arrow) is included in ventricular cavity. D. Oblique sagittal volume-rendered computed tomographic image demonstrates valve planes (arrows) of highlighted left ventricular cavity after manual segmentation. E. Resultant left ventricular ES volume is approximately 49.3 mL. Three commissures (arrows) of aortic valve are clearly noted. F. Oblique coronal volume-rendered computed tomographic image displays valve planes (arrows) of highlighted right ventricular cavity after manual segmentation. AA = ascending aorta, B = blood, ES = end-systolic, LA = left atrium, LV = left ventricle, M = myocardium, PT = pulmonary trunk, RA = right atrium, RV = right ventricle. G. Resultant right ventricular ES volume is 97.6 mL. ES = end-systolic, RV = right ventricle

• 

  Fig. 2 36-year-old male patient with repaired tetralogy of Fallot and left pulmonary artery stent placement.A, B. Two-dimensional short-axis ES cine MR images show manually traced left ventricular cavity (green line in A) and right ventricular cavity (yellow line in B) acquired using simplified contouring method. Papillary muscles and trabeculations are included in ventricular cavity in this method. Magnitude (C) and phase (D) images of through-plane phase-contrast MRI for ascending aorta show semiautomatically drawn vessel outline in red. E. Ascending aortic flow curve is then automatically generated throughout cardiac cycle. Magnitude (F) and phase (G) images of through-plane phase-contrast MRI for pulmonary trunk show semiautomatically drawn vessel outline in red. H. Pulmonary arterial flow curve is then automatically generated throughout cardiac cycle. PR fraction is noted as area under baseline (horizontal arrow). MR = magnetic resonance, MRI = magnetic resonance imaging, PR = pulmonary regurgitation

• 

  Fig. 3 Bland-Altman analysis between ventricular volumes measured using cardiac CT and short-axis cine MRI.A–D. Bland-Altman plots illustrate average bias and degree of agreement in indexed left ventricular ES (A) and ED (B) volumes as well as between indexed right ventricular ES (C) and ED (D) volumes for two methods. CT = computed tomography, ED = end-diastolic, EDVi = indexed end-diastolic volume, ESVi = indexed end-systolic volume, SD = standard deviation

• 

  Fig. 4 Bland-Altman analysis between indexed arterial stroke volumes measured using phase-contrast MRI and indexed ventricular stroke volumes.Bland-Altman plots illustrate average bias and degree of agreement in indexed left ventricular stroke volumes between phase-contrast MRI and CT ventricular volumetry (A), and between phase-contrast MRI and MR ventricular volumetry (B). Bland-Altman plots demonstrate average bias and degree of agreement in indexed right ventricular stroke volumes between phase-contrast MRI and CT ventricular volumetry (C), and between phase-contrast MRI and MR ventricular volumetry (D). PA = pulmonary artery, PC = phase contrast, SVi = indexed stroke volume

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